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UNAIDS 2016 | JC2871

CITIES ENDING THE AIDS EPIDEMIC Meeting report - 6â&#x20AC;&#x201C;7 June 2016 - New York United States of America

KEY MESSAGES

▪Many cities are committed to ending AIDS by 2030 and mayors demonstrate clear leadership for achieving Fast-Track targets. ▪Several cities are getting close to reaching the 90-90-90 targets for 2020 and are on track to end the AIDS epidemic by 2030. ▪City officials reiterate the importance of partnerships in the HIV response and of working closely with all stakeholders in their cities, including civil society, the private sector, affected communities, health departments, and clinical and other service providers. ▪The involvement of communities is crucial to a Fast-Track AIDS response and sustainable urban development. Stigma and discrimination are a barrier to accessing and utilizing HIV services. Mayors identify the elimination of stigma and discrimination as a priority for ending the AIDS epidemic. ▪Mayors are committed to ensuring that no-one is left behind in the HIV response and to protecting the rights of all people affected by and living with HIV. ▪Cities are embracing innovation and the use of granular data and new technologies to accelerate access to HIV services

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Contents Introduction

Cities setting the pace

Uniting as leaders to reach Fast-Track targets

Putting people at the centre of the AIDS response

Seeing the way forward

Annexes

Introduction

Urban leaders and city stakeholders from around the world gathered in New York, United States of America, on 6 June 2016 to demonstrate their commitment to the Sustainable Development Goals and ending AIDS in cities by 2030. The meeting—titled Cities Ending the AIDS Epidemic—was the first in a week-long series of side events and panels in support of the UN General Assembly High-Level Meeting on Ending AIDS. The High-Level Meeting culminated in an agreement on a 2016 Political Declaration on HIV and AIDS, which provides specific, time-bound targets and actions to get the world on the FastTrack to ending the AIDS epidemic. The targets and commitments of the 2016 Political Declaration will guide the world in addressing the critical linkages between health, development, social justice, inequality, poverty and conflict. This document summarizes the proceedings of the cities meeting on 6 June. The meeting was convened by the Mayors of New York and tfParis, together with UNAIDS, the United Nations Human Settlements Programme (UN-Habitat) and the International Association of Providers of AIDS Care (IAPAC), with the support of the M·A·C AIDS Fund. Held at the historic Celeste Bartos Forum in the New York Public Library, the gathering was addressed by mayors, governors, deputy mayors and other city officials from 26 cities around the world, as well as leaders from civil society, multilateral institutions and HIV service providers. Several other delegates in the room provided evidence and made remarks in support of the critical role of cities in Fast-Tracking the 2

response to HIV and ending the AIDS epidemic by 2030. The commitment and leadership of cities was demonstrated through a new report released at the meeting: Cities ending the AIDS epidemic.1 The report testifies to the multiple strategies, actions and achievements in responding to the HIV epidemic. It shows that cities are acting on the seven commitments defined in the 2014 Paris Declaration, Fast-Track Cities: Ending the AIDS Epidemic. The vision of city leaders—and their use of innovative and diverse tools and approaches— will make a fundamental and lasting contribution to achieving the Sustainable Development Goals. By June 2016, more than 200 cities and municipalities around the world had signed the 2014 Paris Declaration, committing to meeting ambitious Fast-Track milestones by 2020, including the 90-90-90 targets (where 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment, and 90% of people on treatment have suppressed viral loads). The Fast-Track approach includes accelerating efforts to prevent new HIV infections and eliminate stigma and discrimination. Progress and innovative solutions for achieving these milestones were the main focus of discussions at the meeting on Cities Ending the AIDS Epidemic.

UNAIDS 2016. Cities ending the AIDS epidemic. Available at http://www.unaids.org/sites/default/files/media_asset cities-ending-the-aids-epidemic_en.pdf.

Cities setting the pace

“We know today that it will be possible to end this epidemic. On this issue, we refuse to be quiet. We will speak out and keep saying that it can be achieved. And we must influence all those governments that have not yet realized that it is possible. It is a matter of will and a matter of focus.” Bill de Blasio, Mayor of New York City

“We cannot let this get worse. We must persevere with treatment, with research, with prevention. Pre-exposure prophylaxis has opened up new opportunities to reach people, particularly gay men, transgender people and sex workers.” Patrick Klugman, Deputy Mayor for International Relations and Francophonie, Paris

The Mayor of New York City, Bill de Blasio, officially opened the meeting by noting that leaders globally had united in a common cause. “It is so incumbent on us, in cities, to set the pace for the entire world,” he said. “We in cities have become used to taking responsibility for larger problems. Cities, by definition, have the strongest connections to their people, and the deepest sense of urgency in meeting their needs and addressing their challenges.” Mayor de Blasio urged mayors to use their voices to advocate for the needs of people who might otherwise be left behind. Celebrating the tremendous progress made in the HIV response in New York City, he noted that HIV prevention, testing, treatment and care should be accompanied by social support if we were to reach the end of AIDS, because people also need “a roof over their head, food to eat, a safe place to live.” Mayor de Blasio encouraged mayors to pursue the end of the AIDS epidemic, saying “let’s recognize the tremendous progress and how close we are now to reaching the 90-90-90 goals. And once we get there, let us take the final step so that we reach everyone.” Entrepreneur and philanthropist Alexandre Mars, Founder and Chief Executive Officer of Epic Foundation, moderated the opening session of the event and noted that his foundation unites experiences from global development, technology and the social and business sectors to support children and youth around the world. Cities, he said, had significant opportunities to leverage philanthropy, private sector innovation and creativity.

Patrick Klugman, Deputy Mayor of Paris for International Relations and Francophonie, addressed the meeting on behalf of the Mayor of Paris, Anne Hidalgo, who was unable to attend because of flooding in Paris. Mr Klugman noted that cities have a critical role to play in the response to HIV. In addition to the importance of scaling up treatment and prevention in Paris— including research into what works—the use of pre-exposure prophylaxis (PrEP) is providing new opportunities to prevent infections among key populations, particularly men who have sex with men, transgender people and sex workers. UNAIDS Executive Director Michel Sidibé noted that cities were champions of public health and had demonstrated their leadership in the AIDS response. “Mayor Hildalgo pushed us to bring cities together,” he explained. “Mayor de Blasio was one of the first to set this goal of ending AIDS, and he wants to push us to do more.” Mr Sidibé pointed out that measures to address the AIDS epidemic had been supported by three major factors: leadership from communities, creativity and innovation, and partnerships and social transformation. Aisa Kirabo Kacyira, Deputy Executive Director of UN-Habitat and former mayor of Kigali, Rwanda, represented UN-Habitat Executive Director Joan Clos. Ms Kacyira spoke about the leadership role of mayors and cities in the 2030 agenda, the importance of engaging community leaders (including among the young, the elderly and people living in poverty), of being informed, of addressing the needs of those who are most vulnerable, and of

making sure that services are accessible, affordable and sustainable. The President/CEO of IAPAC, José M. Zuniga, stressed the importance of monitoring and evaluating local HIV responses. He indicated that timely, city-specific data are needed to help cities gain a precise understanding of gaps in their HIV responses and develop accountability mechanisms to track progress in achieving Fast-Track targets. Nancy Mahon, Senior Vice President of M·A·C Cosmetics and Global Executive Director of the M·A·C AIDS Fund, brought a private sector perspective to the discussion, suggesting that the AIDS response can learn from the business sector and should focus on the needs of “customers.” “Like we say in business,” she said, “the customer is always right. If we keep doing only what we’re doing, we are not going to be able to end this epidemic.” Ms Mahon also called on cities to address the problem of stigma and to ensure that health systems meet the needs of poor people. Phindile Sithole-Spong, Founder and Executive Director of Rebranding HIV (a South African consultancy and media strategy company) and a young woman living with HIV, gave her personal testimony about the stigma and discrimination that surround HIV infection, and the need for HIV to be rebranded to ensure it is better understood as a treatable and manageable chronic condition. UNAIDS Goodwill Ambassador and music legend Annie Lennox delivered a tribute to people living with HIV and those who provide HIV services and support. She urged the mayors to focus and 5

“This is our best chance to break the conspiracy of silence and overcome exclusion. This is centrally about people: the people who are excluded, who do not have a voice, who are living in the slums. Exclusion is not working. We need to be inclusive. We need to reach all those populations—sex workers, gay men, people who use drugs—who are being left behind because of who they are or whom they love,”

accelerate their efforts for ending AIDS. “Thanks to global commitment,” she said, “we have seen extraordinary accomplishments: the numbers newly on treatment in the last five years [and] the decline in new infections. We have the incredible ability to end the AIDS epidemic once and for all in our lifetime. We must ensure immediate treatment for everyone who tests HIV-positive and ensure they receive the support they need. This is not the time to take the foot off the accelerator. Otherwise, all the gains we have made will go into reverse.”

“Attaining the 90-90-90 targets in Fast-Track Cities requires leveraging existing political will, data, programs and resources to close HIV prevention, testing, and treatment gaps and ensure that no one is left behind.”

“We must ensure immediate treatment for everyone who tests HIV-positive and ensure they receive the support they need.” Annie Lennox, UNAIDS Goodwill Ambassador

José M. Zuniga, President/CEO, IAPAC

“HIV must be rebranded. We need to look at HIV not how it was before, but how it is today.” Phindile Sithole-Spong, Founder and Executive Director of Rebranding HIV

Michel Sidibé, Executive Director, UNAIDS

“At UN-Habitat, we believe that we have an opportunity for cities to lead in the 2030 agenda. The Paris Declaration gives us a platform to engage not only national governments, but also cities—those who are closest to the people.” Aisa Kirabo Kacyira, Deputy Executive Director, UN-Habitat

Uniting as leaders to reach fast-track targets “We sat at the bedside of so many young people who made the transition from life to death. Today the situation is dramatically different. We have effective treatment and pre-exposure prophylaxis, and we provide other important support, including housing, nutrition and intensive case management so that people are linked to employment and job training, housing support and cash support, so that they can live full, robust and healthy lives.” Herminia Palacio, Deputy Mayor for Health and Human Services, New York City

“It cannot only be the political leaders that are engaged: all the actors must take this on board.” Bernard Jomier, Deputy Mayor of Paris

An interactive session moderated by Emmanuel Saint-Martin, France24 correspondent, focused on leadership, commitment and progress in FastTracking the AIDS response in cities. Participants explored evidence of cities getting closer to achieving the 90-90-90 and other targets by 2020 and the need to address challenges. The session included discussions on how to engage with civil society and communities in order to ensure that essential services are delivered to all populations in need and that no one is left behind in the response to HIV. It also emphasized the importance of innovations and partnerships that were explored in more detail at side events on the following day. Mayors, governors, deputy mayors and representatives from 15 cities, including Abidjan, Accra, Algiers, Amsterdam, Blantyre, Durban, Ho Chi Minh City, Kingston, Lagos, New York, Paris, San Francisco, São Paulo and Windhoek participated in the discussion, together with representatives from civil society organizations and other partners.

regarded as a low-risk transmission group in the Netherlands. Despite this, challenges remain: many people still do not know their HIV status, and complacency among younger people is a concern. Amsterdam has started to provide pre-exposure prophylaxis to men who have sex with men in order to prevent new HIV infections.

Making progress in the HIV response

Paris developed a strategy to end the AIDS epidemic that was launched in February 2016. Implementation will start in the summer and will focus on migrants and men who have sex with men. As HIV testing is a key component of the strategy, the deputy mayor of Paris urged international organizations to join forces to reduce the cost of self-testing kits and make tests more affordable . Paris is also committed to supporting African cities to develop their own HIV strategies.

While participants reflected on the severity of the epidemic in cities in the early years, several cities celebrated important progress made in controlling the epidemic. Amsterdam, New York City, Paris and San Francisco are close to reaching the 90-90-90 targets and have seen a significant reduction in the number of new HIV infections. Amsterdam has provided needle exchange and opioid substitution therapy for people who inject drugs since the beginning of the epidemic, to the point where people who use drugs are now

New York City has not had any new HIV infections among children in the last 16 months. The city is focused on getting services to people, making sure that they get tested and that those who are HIV-positive are receiving treatment. Moreover, the city is providing social support (such as housing and nutrition) to ensure that people living with HIV stay healthy, along with economic support to all people to make sure that inequalities are addressed. The importance of addressing HIV in a holistic manner— and the provision of basic services such as housing and nutrition—was echoed by Charles King, President and Chief Executive Officer of Housing Works.

The Getting to Zero campaign in San Francisco has used multiple ways to engage people in the HIV response. The city has a long-standing commitment to addressing HIV and associated issues, and it leverages both federal funding and private grants to ensure that the HIV response is well-funded. The city uses the test-and-treat approach and aims to link people to care within 72 hours of a positive HIV test. It also uses a coalition of public and private partnerships to expand the uptake of pre-exposure prophylaxis, with a focus on young men of colour. The city uses social media platforms to do outreach and engage people.

Committing to ending AIDS by 2030 Cities are committed to ending AIDS by 2030 and have shown leadership in efforts to achieve the 90-90-90 targets, the elimination of mother-to-child transmission and other Fast-Track targets. South Africa has committed to achieving the 90-90-90 targets by 2020. The mayor of eThekwini (Durban)—together with the national Department of Health, UNAIDS and other partners—convened a meeting in Durban in March 2016 to encourage the 19 South African cities and municipalities most affected by HIV to join the Fast-Track initiative. Durban city officials are working with community stakeholders to address barriers for access to HIV and tuberculosis (TB) treatment, and to scale up treatment to everybody in need. The city is working towards ensuring that services are accessible to all, including people living in informal settlements, sex workers, men who have sex with men, and migrant truck drivers. Testing services and condoms are 9

“Cities are where the people are: where we get infected or not; where we get treated or not.” Phill Wilson, President and Chief Executive Officer of the Black AIDS Institute

“Our message is that we can end AIDS through an accountable and compassionate community.” Nguyen Thi Thu, Deputy Chairperson of Ho Chi Minh City People’s Committee

being made available through mobile centres and at places like truck stops and taxi ranks. In the city of Windhoek, Namibia, treatment services have been scaled up significantly, and the city is on track to eliminate mother-to-child transmission in the coming years. The city’s strategy started with the development of the Know Your Epidemic, Know Your Response study, which subsequently informed the development of the national HIV strategy. Delivery of services is a key focus of the strategy, and mobile services have been put in place to reach people living in informal settlements. Blantyre, Malawi, has achieved a 67% reduction in mother-to-child transmission and is focused on achieving the elimination of vertical transmission through a number of plans, including providing treatment Option B+ and reaching out to those who do not normally visit health l facilities. The city administration also is working in the community to encourage HIV testing and prevention, and to promote family planning and life skills education. The large numbers of people living in informal settlements is a challenge for the city, but they are working with civil society and have volunteers to reach out to these communities. Ho Chi Minh City, Viet Nam, has been able to mobilize community resources so that people can access prevention and treatment and stay in care. The city believes that it is possible to achieve the 90-90-90 targets and end the AIDS epidemic through an accountable and compassionate community.

While it is essential for cities to commit to ending AIDS—as signified by signing the Paris Declaration—Phill Wilson, President and Chief Executive Officer of the Black AIDS Institute in the United States, reminded cities that intentions alone will not suffice: they must be turned into action. “Cities are where the people are: where we get infected or not; where we get treated or not.” He emphasized the importance of developing networks in cities and how it is crucial that civic leaders ensure a focus on HIV. He also stressed that cities need to be accountable and have measures to evaluate the response.

Facing up to challenges Several cities referred to the challenges that they face in responding to HIV and other health and social issues. These include the large numbers of people migrating in and out of cities, difficulties in reaching growing numbers of people living in informal settlements or slums, and stigmatization and discrimination of people living with HIV (or at high risk of becoming infected with HIV), which can create barriers to accessing services. Gary M. Cohen, Executive Vice President of medical technology company Becton, Dickinson and Company, noted the importance of addressing the needs of adolescent girls and young women. “They are the most affected and infected populations in many countries,” he said. “Many girls report that their first sexual experience was forced. They do

not have choices. Where there is choice about behaviour, then we can influence behaviour.”

Addressing stigma and discrimination and protecting rights City officials underscored the importance of eliminating stigma and discrimination, ensuring that no one is left behind in the response and protecting the rights of all people living with HIV. The Executive Governor of Lagos State, Akinwunmi Ambode, spoke on behalf of 57 mayors of communities that are part of the state. Stigma is of great concern in Nigeria, and efforts need to be intensified to ensure that no one is left behind. Lagos is committed to accelerating the AIDS response, reaching the Fast-Track targets and mobilizing resources. In doing so, he said, diverse stakeholders should be involved in the response to HIV, including faith-based organizations, nongovernmental organizations and civil society. São Paulo, Brazil, has taken a welcoming and harm-reduction approach to working with people who use drugs. Through programmes such as OpenArms, there has been a significant reduction in the use of crack cocaine, and people who use drugs have been provided with care and support. The Health Secretary of São Paulo, Alexandre Padilha, emphasized that: “We have to see key populations not as numbers or targets, but as citizens with rights. Otherwise we will not engage them or keep them in care.”

“We have to see key populations not as numbers or targets, but as citizens with rights. Otherwise we will not engage them or keep them in care.” Alexandre Padilha, Health Secretary of São Paulo, Brazil

“Programmes need to reach sex workers [and] men who have sex with men. The good thing is that our clinics are accessible: we have mobile stations, services available at the truck stops to provide condoms and HIV testing.” James Nxumalo, Mayor of eThekwini (Durban)

“Every part of local government needs to be involved in the HIV response.” Akinwunmi Ambode, Executive Governor of Lagos State, Nigeria

Engaging communities and raising awareness Efforts to involve communities and raise awareness and advocacy for supporting the Fast-Track cities approach were raised by several cities and partners. The Deputy Secretary-General of ASEAN, Vongthep Arthakaivalvatee, called for attention to advocacy and raising awareness, explaining that “the ASEAN social and cultural community has taken on the promotion of healthy lifestyles, and we have been able to bring in and support the HIV response.” Angela Brown Burke, the mayor of Kingston, noted that differences exist between countries, cities and even within communities. Her own community’s response to the AIDS response has been mixed. “Some welcome the level of advocacy I bring to the issue,” she said. “Some do not like that I bring visibility and attention to groups that they don’t think should be seen or heard. Sometimes we forget that the reality on the ground varies from city to city, country to country.” She also pointed out that community engagement need not be complicated, and that simple actions—such as viewing a video, talking about stigma and discrimination, or getting an HIV test—could be very successful in bringing the community on board. In Sidi M’Hamed, Algiers, civil society has been mobilized to foster an environment that achieves results and is efficient.

Embracing innovation and partnerships Cities are embracing innovation and the use of new technologies to advance the HIV response. Abidjan, Côte d’Ivoire, has developed a partnership with Orange, a telecommunications company, to promote public health, generate data and reduce the spread of HIV. With a mobile technology penetration rate of 100%, this development will allow city authorities to be closer to affected people, and it will make people more aware of what it means to be on effective treatment. It also will help to identify barriers to treatment, including stock-outs of medicines. These themes were explored in detail in a separate meeting on 7 June, when mayors, civil society representatives and other urban stakeholders met with private sector companies and scholars at the United Nations headquarters to explore leveraging innovations and financing for ending AIDS. Alongside the UN General Assembly HighLevel Meeting on Ending AIDS, participants joined several panel discussions and an innovations marketplace to explore how smart cities can use new technologies and approaches to transform their response to HIV and other health issues. Those events examined the key challenges in city responses to HIV, as well as health and development more broadly. They also illustrated emerging and available technologies and innovations in the areas of information technology, mobile and data apps, science, pharmaceuticals and diagnostics, and finances that can help cities and Member States Fast-Track their HIV responses.

Speakers from the private sector, service providers, civil society, academia and research institutes discussed the latest scientific findings, as well as the practical implementation of cutting-edge approaches. IAPAC demonstrated Fast-Track City dashboards for the visualization of HIV care continuum data that will also map local HIV testing, prevention, care and treatment services and ultimately serve the function of monitoring cities’ progress in achieving the 90-90-90 and other FastTrack targets. Other data visualization approaches were discussed, including the UNAIDS Situation Room and the iMonitor app. Mobile network operator Orange presented its project for mobile phone users to provide actionable health data and receive useful health care information. Other service providers discussed point of care diagnostics and transportation drones for delivering essential health commodities and providing rapid access to medical tests. More than 20 innovators were present at the event to discuss how technologies can help achieve FastTrack targets in different contexts, and how they could develop novel partnerships for innovation and service delivery.

Putting people at the centre of the aids response “If we unite our action and energy, we can stop this problem, not just in one city or region, but around the world. As President of the Association of Cities in Ukraine, I am responsible for talking about this epidemic across Ukraine, in our largest cities. By working together, we can move faster and with more impact.” Vitali Klitschko, Mayor of Kyiv, Ukraine

“I don’t think we can end AIDS by 2030 if we continue to criminalize key populations. Once we decriminalize [them], that may play a big role in reducing the stigma and discrimination that reduces access to services.” Simon Beddoe, Advocacy Officer for Drug Use and Harm Reduction for the India HIV/AIDS Alliance

On the afternoon of 6 June, Pablo Illanes, a Partner at McKinsey & Company in New York, moderated an interactive session on the importance of partnerships in accelerating the HIV response and how to engage with people living with HIV and populations at high risk of HIV infection. Mayors, governors, deputy mayors and representatives of cities and several civil society organizations participated in the discussion. The participating cities included Addis Ababa, Casablanca, Dakar, Douala, Kyiv, Mexico, Mumbai, Panama, Quezon and Salvador de Bahia.

Partnering with city stakeholders Mayors acknowledged the importance of partnerships in the HIV response and of working closely with stakeholders in cities. Vitali Klitschko, the Mayor of Kyiv, Ukraine, spoke alongside Olga Gvozdetska, the Director of Programming at the All-Ukrainian Network of People Living with HIV, and they jointly emphasized the importance of involving civil society in the HIV response. Prioritising HIV testing and timely treatment initiation was highlighted, but it was acknowledged that stigma can undermine efforts to reach key populations. Despite this, Kyiv is united in the fight against HIV, and the city is aiming to reduce stigma in health care settings to ensure that people can access and remain in care.

In Dakar-Guediawaye, Senegal, there is optimism that multiple organizations are working to support people living with HIV. Partnerships are also developed between people living with HIV and health professionals, who have an important role to play in advocating for HIV testing. For instance, a women’s organization funded by city authorities establishes support groups to help people living with HIV maintain their dignity. The Mayor of Douala, Cameroon, called on partners in the private sector and civil society to work together to strengthen prevention activities and support the city in reaching its targets. The city hosts an event for youth in February each year and uses this as an opportunity to promote prevention, provide HIV services and information and involve the community. In Mumbai, the HIV epidemic is concentrated among key populations. HIV prevention efforts have focused on these groups, and civil society organizations in Mumbai play a critical role in providing essential support. Mayor Snehal Ambekar reaffirmed Mumbai’s commitment to Fast-Tracking the HIV response.

Sienna Baskin from the Urban Justice Center’s Sex Workers Project in New York, said that the ambitious treatment and prevention targets cannot be achieved unless cities reach key populations. While cities provide anonymity for people, this also means that they can be hard to reach and that they can miss out on essential health services, such as clean needles, opioid substitution therapy or HIV treatment. In addition, criminalization of key populations in many countries is a major barrier because it reduces the access to testing, treatment and other services, and it increases the risk of transmitting HIV. Mexico City has been innovative in its care and treatment programmes for transgender women. There are approximately 5000 transgender women living in Mexico City, among whom HIV prevalence is approximately 40%. The city offers them free hormone replacement therapy, which acts as an incentive for transgender women to attend available facilities, where they can also receive HIV treatment free of charge.

Participants acknowledged that a focus on key populations and other vulnerable groups, including people living with HIV, is essential to ending the epidemic and reaching ambitious targets.

The AIDS epidemic in Casablanca, Morocco, is concentrated among key populations, and the response is therefore focused on these groups. Sex workers and migrants are provided with regular testing services, and people who are found to be HIV-positive are referred for immediate treatment. This test and treat approach will help the city— which is committed to ending AIDS by 2030—reach the 90-90-90 targets.

Civil society representatives, including Simon Beddoe from the India HIV/AIDS Alliance and

Salvador de Bahia, Brazil, has an HIV epidemic concentrated mainly among key populations. It

Engaging people in the response to HIV

“Biomedical solutions are fundamental to ending AIDS, but without a focus on key populations, we won’t reach 90-90-90.” Sienna Baskin, Co-Director of the Sex Worker Project, Urban Justice Center, New York City

“We have established alliances with [nongovernmental organizations] that can do a better job than local authorities working alone, and they can do more if we help them and we work together, all to achieve the goals of the Paris Declaration.” José Isabel Blandón Figueroa, Mayor of the District of Panama

has increased the number of HIV centres from one to three, tripling access; the city also has signed technical cooperation agreements with UNAIDS and is implementing campaigns to reach people with HIV services.

Removing barriers to HIV prevention and treatment Stigma and discrimination heavily affect vulnerable populations, and they are a barrier to HIV prevention and treatment access. This makes addressing them a priority.

the goals of the Paris Declaration. The Mayor of Panama District, José Isabel Blandón Figueroa, commented on the importance of civic leadership in the HIV response. “I personally attended the Gay Pride parade last year,” he said. “It generated quite a bit of discussion in the city. We need to lead by example.” Quezon City in the Philippines was the first city to open a stigma-free clinic for men who have sex with men that features flexible opening hours. With the support of UNAIDS, the city is advocating for

people to “get tested, know your status,” and for people who are HIV-positive to get treatment. The city has expanded its outreach and opened clinics in other parts of the city. The commitment to reach the 90-90-90 targets and end the AIDS epidemic by 2030 was echoed by Addis Ababa, Ethiopia, where the Fast-Track approach has revitalized the city’s response. The city is focusing its response on areas of high and resurging transmission, and its efforts are guided and inspired by initiatives in cities across the world.

Simon Beddoe pointed out that decriminalization of key populations may play a large role in reducing the stigma and discrimination that reduce access to services.

Sienna Baskin noted that many of the laws that criminalize sex work might be at the state or national level and thus out of city control. Cities can, however, fund outreach for key populations and research into how criminalization is affecting key populations and increasing HIV vulnerability. In instances where they control police forces, cities can also order that sex work-related offences be given lower enforcement priority. The District of Panama has adopted a decree guaranteeing non-discrimination and the protection of human rights for all people, including lesbian, gay, bisexual and transgender people and people living with HIV. It has established alliances with nongovernmental organizations to help achieve

Seeing the way forward

“Political leadership is essential: standing up for people who do not always have a voice. Thinking back, there have been other opportunities in history to end diseases, and the world did not seize the moment. The mayors here will not let this opportunity slip through their fingers. We have to deal with the epidemic that we have, not a model epidemic. We have to deal with the access issues, the human rights issues, all the things that stand in the way of reaching people and success in ending the AIDS epidemic.” Ambassador Deborah Birx, United States Global AIDS Coordinator

“The core of the response is with the people, in the communities. As we get close to them, we do better.” Dr Luiz Loures, Deputy Executive Director, UNAIDS

UNAIDS Deputy Executive Director Luiz Loures moderated the closing section of the event, and he noted that cities were adopting local responses to a global epidemic and that their local actions were contributing to the global response to HIV. Dr Loures also acknowledged the leadership of the United States in its global HIV policy, resource mobilization, scientific research, technical and implementation support to the AIDS response in many countries. United States Global AIDS Coordinator, Ambassador Deborah Birx, described it as “a privilege” to engage with the mayors, learn about their experiences in working with key populations and address structural issues that are increasing people’s risk of HIV infection. She pointed out that technical, financial and political leadership are all needed to accelerate the HIV response. Furthermore, the response has to take services to where the needs are, and city authorities need to deal with local issues and local barriers.

Amy Lansky, Acting Director of the United States Office of National AIDS Policy, noted that the United States released the National HIV/AIDS strategy: updated to 2020, which can serve as a guide for governments, civil society and partners— including cities. “We have known that cities are critical to the national response,” she explained. “We have to think about innovations in the social contexts that affect our work, including addressing stigma and discrimination. We know that these must be addressed to overcome barriers to

testing, treatment and care.” She pointed out that strategies need to focus on policy issues and service delivery, and engage all partners, as the core of the response to HIV should be at the community level. Dr Lansky called on cities to build on the past but to do better in future, and in closing, quoted US President Barack Obama from his White House statement on 5 June 2016, which commemorated 35 years of AIDS in the United States: “I’m confident that if we build upon the steps we’ve taken, we can finish the job.”

Ambassador Birx spoke about the importance of using data to identify and understand the challenges and barriers. Data about the HIV epidemic and the impact of programmes create new opportunities for cities. “We are using data in a new way, a granular way,” she said, “and when we do that, in every place that we look, each population in each community has a different issue vis-à-vis the treatment cascade. That’s the exciting part of the work: look at the information, constantly question our assumptions, put in place the good policies that will drive change.”

Annex 1. Speakers and moderators

Hon Muesee Kazapua, Mayor, Windhoek

Other presenters

Hon Vitali Klitschko, Mayor, Kyiv, Ukraine

H.E. Vongthep Arthakaivalvatee, Deputy Secretary General of ASEAN

H.E. Yeo Klotioloma, Deputy Governor, Abidjan, Côte d’Ivoire

City representatives Dr Armando Ahued, Secretary of Health of Mexico City, Mexico Hon Snehal Ambekar, Mayor, Mumbai, India H.E. Mr Akinwunmi Ambode, Executive Governor, Lagos State, Nigeria Mr Girma Ashenafi Ayele, Head, Addis Ababa Health Bureau, Addis Ababa, Ethiopia Hon Herbert M. Bautista, Mayor, Quezon City, Philippines

Hon Patrick Klugman, Deputy Mayor, International Relations and Francophonie, Paris, France

Ms Sienna Baskin, Co-Director, Sex Workers Project, Urban Justice (New York) Mr Simon Beddoe, Senior Advocacy Officer Drug Use & Harm Reduction, India HIV/AIDS Alliance

Hon Fritz Ntonè Ntonè, Délégué du Gouvernement auprès de la Communauté Urbaine de Douala, Cameroon

Amb. Deborah Birx, UN Global AIDS Coordinator, United States President’s Emergency Fund for AIDS Relief (PEPFAR), USA

Hon James Nxumalo, Mayor, Durban (eThekiwini), South Africa

Ms Olga Gvozdetska, All-Ukrainian Network of People living with HIV, Kyiv Branch, Kyiv, Ukraine

Hon Alexandre Padilha, Health Secretary, São Paulo, Brazil

Ms Aisa Kirabo Kacyira, Deputy Executive Director, UN-Habitat Dr Amy Lansky, Acting Director, Office of National AIDS Policy, USA

Hon Bill de Blasio, Mayor, New York City, USA

Hon Herminia Palacio, Deputy Mayor of Health, New York, USA

Hon Eric van den Burg, Deputy Mayor, Amsterdam, the Netherlands

Hon Nabila Rmili, Deputy Mayor of Casablanca, Morocco

Hon Angela Brown Burke, Mayor of Kingston and St Andrew Corporation, Jamaica Hon Noel Chalamanda, Mayor, Blantyre, Malawi

Hon Aliou Sall, Mayor of Guediawaye and President of the Senegalese Mayor’s Association, Dakar, Senegal

Ms Aneeka Chaudhry, Senior Health Advisor, San Francisco, USA

Hon Célia Oliveira de Jesus Sacramento, Deputy Mayor, Salvador de Bahia, Brazil

Hon José Isabel Blandón Figueroa, Honorable Señor Alcalde del Distrito de Panamá, Panama

Madam Nguyen Thi Thu, Vice Chairwoman of City, Ho Chi Minh City People’s Committee, Viet Nam

Ms Phindile Sithole-Spong, Founder and CEO, Rebranding HIV, Zimbabwe

Hon Bernard Jomier, Deputy Mayor, Health, Handicap and Relations with Hospitals, Paris, France

Hon Nasereddine Zenasni, Maire de Sidi M’Hamed, Algiers, Algeria

Mr Phill Wilson, President and CEO, Black AIDS Institute, USA

Ms Annie Lennox, UNAIDS International Goodwill Ambassador Dr Luiz Loures, Deputy Executive Director, UNAIDS Ms Nancy Mahon, Executive Director, M·A·C AIDS Fund Mr Michel Sidibé, Executive Director, UNAIDS

Dr José M Zuniga, President and CEO, International Association of Providers of AIDS Care, USA

Moderators Mr Alexandre Mars, Founder and CEO, Epic Foundation Mr Emmanuel Saint Martin, Correspondent, France 24 Mr Pablo Illanes, Partner, McKinsey & Company

Annex 2. The Problem Solvers: Cities on the Front Lines of HIV/AIDS

Michel Sidibé, Executive Director, UNAIDS

Mindy Fullilove

Nancy Mahon, Global Executive Director, M·A·C AIDS Fund

Brad Sears

The City Politics of HIV/AIDS Following the Cities Ending the AIDS Epidemic on 6 June, the Atlantic Media Company of the United States held a separate event, entitled The Problem Solvers: Cities on the Front Lines of HIV/AIDS, that was presented by M•A•C AIDS Fund and UNAIDS. This event consisted of a series of discussion panels with mayors, global health leaders and advocates who discussed issues of equality and discrimination: “From Paris, to Kingston, to New York City, could the catalyst for universal change start in the city square?”

Demetre Daskalakis, Assistant Commissioner of the Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene Mindy Fullilove, Professor of Clinical Sociomedical Sciences and Psychiatry, Columbia University Mailman School of Public Health Brad Sears, Executive Director of the Williams Institute, UCLA School of Law Indira Lakshmanan, Contributor, Politico Magazine and The Boston Globe

The panels focused on paths to improving systems for HIV education, testing and treatment, engaging marginalized populations around major health issues, setting goals and building global leadership. The Atlantic Forum was filmed in its entirety and is available to view online at https://lc.cx/4FJV

Power of the People

Ending AIDS in Cities: A Conversation on Leadership

Demetre Daskalaki

Vanessa Kerry, Founder and CEO, Seed Global Health Cara Page, Executive Director, Audre Lorde Project

Indira Lakshmanan

The Role of Cities in Global Health Angela Brown Burke, Mayor of Kingston, Jamaica James Nxumalo, Mayor of Durban, South Africa Alex Wagner, Senior Editor, The Atlantic

The Way Forward Micheal Ighodaro, Program and Policy Assistant, AVAC Alexandre Mars, Founder and CEO, Epic Foundation Rebecca Rosen, Associate Director for Data Resources and Data Strategy at the Center for Urban Science and Progress, New York University Matthew Slutsky, Managing Director of Partnerships, Change.org Angela Brown BurkeJames Nxumalo Alex Wagner

Presented by M·A·C AIDS Fund and UNAIDS Bernard Jomier, Deputy Mayor of Paris, France Annie Lennox, Singer, Songwriter, Activist and UNAIDS Global Goodwill Ambassador

Annex 3. Additional resources

The following documents provide evidence of commitments, progress and results among cities towards ending the AIDS epidemic, and they provide insights, strategies and guidance for citybased responses to HIV. 2016 report: Cities Ending the AIDS Epidemic (UNAIDS; 2016 (http://www.unaids.org/sites/ default/files/media_asset/cities-ending-the-aidsepidemic_en.pdf)

Fast-Track cities: update 2015. Geneva: UNAIDS; 2015 (http://www.unaids.org/sites/default/files/ media_asset/JC2815_2015_Dec_update_Fasttrack_cities_en.pdf).

On the Fast-Track to end AIDS by 2030: focus on location and population. Geneva: UNAIDS; 2015 (http://www.unaids.org/en/resources/ documents/2015/FocusLocationPopulation).

Local epidemics issues brief. Geneva: UNAIDS; 2014 (http://www.unaids.org/sites/default/files/ media_asset/JC2559_local-epidemics_en.pdf).

The Paris Declaration on Fast-Track Cities: Ending the AIDS Epidemic (2014 (http:// www.unaids.org/sites/default/files/media_ asset/20141201_Paris_Declaration_en.pdf).

Location, location: connecting people faster to HIV services. Geneva: UNAIDS; 2013 (http:// www.unaids.org/sites/default/files/media_asset/ LocationLocation_en.pdf).

UNAIDS Outlook 2014: The Cities Report. Geneva: UNAIDS; 2014 (http://www.unaids. org/sites/default/files/media_asset/JC2687_ TheCitiesReport_en.pdf)

Cities unite to Fast-Track to end the AIDS epidemic. Event summary: taking action, World AIDS Day 2014. Geneva: UNAIDS; 2014 (http:// www.unaids.org/sites/default/files/media_ asset/2015_Fast_Track_Cities_Paris_Outcomes. pdf). Ending the AIDS epidemic: the advantage of cities. Nairobi: UN-Habitat and UNAIDS; 2015 (http://www.unaids.org/sites/default/files/media_ asset/20150918_Ending_urban_AIDS_epidemic_ en.pdf). Fast-Track: ending the AIDS epidemic by 2030. Geneva: UNAIDS; 2014 (http://www.unaids. org/sites/default/files/media_asset/JC2686_ WAD2014report_en.pdf).

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